Internist Ana Maria Lopez: Opportunities for action

For Ana Maria Lopez, MD, MPH, FACP, the new president of the American College of Physicians, looking toward the future of medicine means first looking to her own past.

As the child of two pathologists, Lopez remembers sitting around the dinner table while discussions of the day’s tissue slide discovery was the main topic. She also remembers matter-of-factly announcing a “syncopal episode” as a six-year-old to her teachers on the playground one day when a classmate passed out.

“I remember thinking, back to age three or four, that I wanted to go into medicine but somehow knowing that I was going to be a different type of doctor [than my parents], because I was going to talk to patients,” Lopez says. “I really remember wanting to be there for people.”

She attended Bryn Mawr College in Pennsylvania, worked in a women’s health clinic, which she continued doing after graduation, and in 1988, earned her medical degree at the Sidney Kimmel College of Medicine of Thomas Jefferson University.

She moved to Arizona for her residency, later serving as medical director of the University of Arizona’s telemedicine program. In 2004, she was named one of the “Best Doctors in Tucson” by a local publication-a list she’d continue to appear on for years to come.

Lopez recently returned to Thomas Jefferson University as vice chair of medical oncology. This happened to coincide with another Philadelphia-based honor, serving as the 2018-2019 president of the American College of Physicians for a one-year term.

As only the seventh female physician to hold the distinction in the organization’s 103-year history (most presidents serve only one-year terms), Lopez is well aware of the significance of her new role. And if she needed any reminding, her office at the ACP’s headquarters features an eight-foot cardboard cutout of Elizabeth Blackwell, MD, the first woman to gain her medical degree in the United States, that sits right next to her desk.

Medical Economics recently visited Lopez for a wide-ranging question-and-answer session. An excerpt of that interview follows.

MEC: How do you view the state of women in medicine today?

Ana Maria Lopez: It’s true that we’ve come a long way, and that’s incredibly positive. When I reflect back on the women who preceded us, I think of my mother who was one of three women medical students in a class of about 200. Those were pioneers, and they paved the way. So I have incredible gratitude to the women that came ahead [of me].

But there still are a lot of issues. There’s pay equity, [which is a] big issue. There are family leave policies. Here we are in 2018, and that’s still an issue. It’s pretty significant. And then there’s leadership development, career development, mentorship, all of those areas … where making an impact in any of those areas is not a benefit only for women, it’s a benefit for everybody.

Sometimes we have this [thought process] that if women get paid more, somebody is going to have to be paid less. It’s not that sort of thing. You raise the level for women; you raise the level for everyone. So pay equity is critically important, and we are in a society where that’s how value is measured.

We have family leave [as an issue], and we’re not talking just for women, and we’re not talking just about being pregnant, but adoption, and caring for elders. We really want to be a community where it’s acknowledged that people have personal lives, and they have needs and demands in those lives, and they can take time to take care of those needs.

Then there’s leadership development, faculty development, and career development; [these are] so important for everyone. This is what allows young people to really be the best that they can be. And it also gives a responsibility to all of us who have benefitted from those opportunities to help people who are earlier in the ­process.

I always remember people that have been meaningful in my life. There was a radiology professor and I was always in awe of him because he would look at films and what he could see was incredible. And I would always say, ‘it’s just amazing how much he knows.’ And then one time he said, ‘we’re all on a learning curve, we’re just at different points.’ And so that spoke to me.  …It’s incumbent on me to share what I know.
There’s a long way to go and there’s a long way to go that will not be alienating to our male peers because it will improve life for everyone.

MEC: What is the ACP doing or what do you feel like you can do in this position to promote some of the issues that you mentioned?Lopez: We need data. For my first job, I met with my division chief; my division chief said ‘welcome, you’re a new research assistant professor and here’s your salary’ and I just said ‘thank you.’ I didn’t know the market or what any of that is. Having data available and having it published can make such a difference.

For academic medicine, for example, the Association of American Medical Colleges has a book and you go in there by specialty, by rank, by part of the country, it will say, here’s kind of what you should expect. Just to have that available is a great first step.

At my former institution, there was a clear effort to have data, for example, by rank. Here’s where people tend to be as assistant professor, here’s where people tend to be as associate, and so on. And, if someone was being paid way high or way low there would be a flag.

So, there are folks that are looking. Maybe you just hired an assistant professor who is a man for this amount and now you’re hiring an assistant professor who is a woman at a much lower or much higher amount, how come? And ask for a rationale, to understand why that is. Having data allow for those sorts of questions to be raised, and then it’s not just, ‘it’s just how it is.’

MEC: What does it mean to you to be in this position of leadership at ACP, both as a physician and as a woman?

Lopez: What I love about the ACP is the coming together of different perspectives to talk deeply about a topic, to respect differences, and to learn from each other, so you actually end up in a new place than where you started from, a place from where we can move forward.

That is incredibly powerful and that, to me, is really what medicine is about, the capacity to always learn and move actionable knowledge forward. There’s also the responsibility of being a role model. I remember a student saying to me once that she’d heard me give a talk, and that made her think, maybe I could do that. In being a role model, we have to remember, you don’t always know when you’re serving that role.

MEC: What do you think are the biggest challenges facing internal medicine physicians today?

Lopez: Probably the area that holds the greatest risk is the high level of burnout. When you think that for physicians, it is basically the equivalent of a whole medical school class that commits suicide each year, that’s pretty striking. Thinking about the factors that may contribute, perhaps sense of loss of control, being pulled in too many directions, and too much burden, we can think about the opportunity for action. 

The American College of Physicians has resources that can help around wellness, can help around administrative burden, can foster resilience, and help create medical organizational structures that actually help clinicians be well.

MEC: How do you personally make the time and make sure you maintain balance? How do you avoid burn-out and getting professionally frustrated?Lopez: Time is the most valuable thing that we have. It’s the most valuable gift. Even with my children, one of the things we talk about is, I don’t need another [thing]; I need time together. I really take that to heart, any time that I’m with someone to really try to be as present as possible and to be as focused as possible.

I find that not feeling the pressure of what else I could be doing, not trying to think, ‘oh, I could be doing such and such’ is helpful. I’m a very visual person, so I used to have this vision that I’d be doing whatever I was doing, but I had this parallel mind that was ticking off what I could be doing and what I needed to do later. Now, I’m more present, and that gives me more time and more energy.

Making that shift was really important for me as far as patient care. Whatever time I have with the patient, I value. I know we can feel the stress and strain of time during a visit, whatever amount of time, it may well not be enough.

It was a mentor of mine who said to me, ‘when you are in a hurry, make haste slowly.’ So, walk into the [exam] room, and it is a kind of sacred space, drop in, be present, and there’s time.

MEC: What are your thoughts regarding the changes in terms of healthcare delivery since the election?

Lopez: There is a sense that folks [in Washington, D.C.] are listening. How that will translate into policy, we’ll see. And there can be ramifications that may be unintended. There’s a lot to look at. There’s been a lot of conversation around performance measures.

I’m convinced, as I travel and meet internists across the U.S. and internationally, everybody wants to do a good job. There’s not a sense that I don’t want to do the right thing, but how we measure is so important. Are we measuring the right thing, and are we measuring what really impacts patient care?

Thinking about performance measures and working with our colleagues that are working in that space is very, very important. The House Ways and Means Committee has had a couple of roundtables all around red tape, and ACP has been very fortunate to have been able to participate in those.

There are some rules that are out for comment now, and we ask for members’ input. And ACP will be providing feedback. Again, something that I very much value about the American College of Physicians is that there’s communication in both directions, including hearing closely from members. The ACP has a center that focuses on patients, hearing from patients, hearing from caregivers, hearing from families, and keeping the patient at the center.

As the ACP provides comments on policy topics, that’s the perspective we bring to the table.

MEC: Do you feel like the nation’s internists still rely on and trust the ACP to represent them?

Lopez: In going to chapter meetings and going to different forums and meeting people, there’s so much kinship to the college. And there’s so much that people really find of value which is very, very heartening.

And at the same time, there’s this tremendous opportunity to listen and to understand because there really are regional differences. There are lots of different types of practices and even within the type of practice there may be regional differences.

There needs to be a lot of communication. One of the things that I may hear is, ‘oh I wish the College were doing something here.’ And we may be. We just haven’t communicated it well enough to let people know about it. It’s great to hear the tremendous kinship that people have for the American College of Physicians, and to listen, learn, and find ways to share better.

MEC: What about those who aren’t ACP members?

Lopez: There can be a variable sense of frustration just around where medicine is right now. My response to that is: We have to be a part of the solution. The ACP is part of the solution. Join us.

The practice of medicine is different than it was 10, 20, certainly 50 years ago. Going back is not a viable solution. We have to come together for the benefit of our patients, People need care today.